| NPI | 1093923617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: OH 35.092409) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301085051) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2019-09-05 |